Lower Limb Orthopedic Surgery Research Articles

Prospective study of post-operative hyponatremia in patients undergoing lower-limb orthopedic surgery

Prospective study of post-operative hyponatremia in patients undergoing lower-limb orthopedic surgery

Comparative Study of Dexmedetomidine versus Fentanyl as an adjuvant to Ropivacaine (0.75%) in Epidural Anaesthesia in Lower Limb Orthopaedic Surgery

Background: Dexmedetomidine and Fentanyl both possess hypnotic, sedative, analgesic properties and have been utilised as an additive in epidural anaesthesia. The purpose of this study is to compare the sedative and analgesic effects of Dexmedetomidine and Fentanyl when added epidurally with Ropivacaine (0.75%) during lower limb orthopaedic surgery.
 Methods: The study comprised of 60 patients, both male and female, aged 18 to 60, who had ASA classification I or II for tibia fibula surgery. Two groups of patients were split up at random: Group RD contains– Ropivacaine (0.75%) 15ml + Dexmedetomidine (1microgm/kg) 0.5ml + 0.5ml sterile water (Total volume-16ml) and Group RF - Ropivacaine 15ml (0.75%) + 1ml Fentanyl (1microgm/kg) (Total volume-16 ml). The epidural space was maintained 4 cm within and situated between L3 and L4 space. Investigations were conducted on parameters such as sensory and motor block features, sedation score, hemodynamic factors and pain assessment. Using the student `t` test, statistical analysis was performed using STATAIC13 software.
 Results: Onset of sensory analgesia at L1 and Complete sensory and motor blockage occurred much earlier in the RD group. Higher sedation scores and significantly prolonged postoperative analgesia was observed in RD group.
 Conclusion: Dexmedetomidine is a safer and more effective epidural adjuvant than fentanyl because it provides stable hemodynamics, extended post-operative analgesia, early onset and development of sensory and motor effects and sedation.

Comparison of metabolic rates of ropivacaine in cerebrospinal fluid as inferred from plasma concentrations between elderly patients and young patients

BackgroundWith the aging of human society, more and more elderly patients have to undergo surgery and anesthesia. Clinical observations have indicated from time to time that spinal anesthesia in the elderly appears to last longer than in young people, although there is limited research in this area and the mechanism is unclear at present time. This research work is expected to help understand the decline of local anesthetic metabolism in cerebrospinal fluid of elderly patients so as to help them with precise anesthesia and rapid rehabilitation.MethodsTwenty patients with spinal anesthesia in orthopedic lower limb surgery were selected to study the rate of drug metabolism in cerebrospinal fluid in two age groups, i.e.,18–30 years old and 75–90 years old. Ropivacaine in peripheral blood is used as a probe to reflect the speed of drug metabolism in cerebrospinal fluid. The contents of total Aβ protein and hyaluronic acid in the cerebrospinal fluid were investigated as well.ResultsThe equivalent dose of ropivacaine anesthetizes the elderly group for a longer time. The metabolism rate of ropivacaine in an elderly patient was slower than that of a young patient. No significant difference in total Aβ protein between the two groups was observed while hyaluronic acid in the elderly group was significantly higher than that in the young group.ConclusionsThis study shows that the dose of ropivacaine should be reduced when used for anesthesia in elderly patients. The cumulation of ropivacaine and HA appears to imitate the degeneration of central lymphatic circulation metabolism in elderly people.

Neuropathic pain after orthopaedic surgery with continuous peripheral nerve block.

Continuous peripheral nerve blocks (cPNBs) have shown favourable post-operative pain control results but may be associated with a risk for long-term neurological complications. This study sought to examine factors associated with persistent post-operative pain and potential neuropathy after orthopaedic lower-limb surgery with the use of post-operative cPNB. Patients who underwent lower limb orthopaedic procedures with cPNBs between November 2021 to May 2022 were included. Patient demographics and perioperative data were noted. At discharge, patients completed the PainDetect (PD) questionnaire and were followed up six months after discharge. Seventy-seven patients with a total of 171 catheters completed the follow up. The median time to follow-up was 214 days after catheter removal, and 18 patients (23%) had a PD score ≥ 13. Univariate analysis showed that multiple variables were associated with a PD score ≥ 13 at the six-month follow-up. Multiple logistic regression showed that a high PD score at discharge, high BMI and longer duration of cPNBs were associated with higher risk of having a PD score ≥ 13 at the six-month follow-up. Several factors were associated with a higher risk of having possible neuropathy after six months. BMI, duration of catheter and PD score at discharge were correlated with risk of possible neuropathic pain. None. The study was a quality control project and therefore did not require registration under Danish law.

Effect of Low-Dose Dexmedetomidine on Intestinal Barrier and Functional Recovery in Elderly Patients Undergoing Orthopedic Surgery for Lower Limbs

Objective: This study used the minimum recommended clinical dose of dexmedetomidine to investigate whether it can protect the intestinal barrier and the effects on intestinal function recovery in elderly patients undergoing lower limb orthopedic surgery. Methods: 56 patients, who underwent elective lower limb orthopedic surgery in our hospital from November 1, 2019 to November 1, 2021, were divided into control group (saline group) and DEX group (dexmedetomidine group) by random numbers method. The DEX group received dexmedetomidine at 0.5 μg/kg, pumped within 15 min and then maintained at 0.1 μg/kg/h until 30 min before the skin suture. The control group performed the same procedure with normal saline instead. The primary outcomes included the time of first hepatic gate exhaust, serum diamine oxidase, and D-lactate levels. Secondary outcomes include total amount of sufentanil, mean arterial pressure, heart rate, duration of anesthesia, duration of surgery, tumor necrosis factor- α, C-reactive protein, lipopolysaccharide levels. Results: The time of first anal exhaust in the DEX group was significantly shorter compared with the control group (13.23 ± 4.98 hours vs19.67±5.16 hours; p<0.001), and the total amount of sufentanyl in the DEX group was significantly lower than that in the control group (35.32±10.23ug vs 42.33±12.19ug; p=0.002). At 24 hours after surgery, serum diamine oxidase, tumor necrosis factor-α, and C-reactive protein levels increased in both groups, but no difference was statistically significant (p>0.05), and there was no significant difference in LPS levels in the two groups before and 24 hours after surgery (p>0.05). D-lactate was increased in both groups at 24 hours after surgery, but the D-lactate increased more in control patients than in the DEX group (36.17±14.69 mg/L vs 29.10±12.19 mg/L;p=0.017). Correlation analysis showed that diamine oxidase, D lactate, age, APACHE II score, total amount, and time to first anal discharge in the DEX group (p<0.05). Conclusion: The intraoperative administration of dexmedetomidine can accelerate the recovery of gastrointestinal function, which may be related to the protective effect of DEx on the gastrointestinal barrier.

CAN WE USE SMARTPHONES TO MONITOR ORTHOPAEDIC PATIENTS' PHYSICAL ACTIVITIES DURING THE PERIOPERATIVE PERIOD? A PROSPECTIVE OBSERVATIONAL STUDY

Smartphones are often equipped with inertial sensors capable of measuring individuals' physical activities. Their role in monitoring the patients' physical activities in telemedicine, however, needs to be explored. The main objective of this study was to explore the correlation between a participant's daily step counts and the daily step counts reported by their smartphone. This prospective observational study was conducted on patients undergoing lower limb orthopedic surgery and a group of non-patients. The data collection period was from 2 weeks before until four weeks after the surgery for the patients and two weeks for the non-patients. The participants' daily steps were recorded by physical activity trackers employed 24/7, and an application recorded the number of daily steps registered by the participants' smartphones. We compared the cross-correlation between the daily steps time-series taken from the smartphones and physical activity trackers in different groups of participants. We also employed mixed modeling to estimate the total number of steps. Overall, 1067 days of data were collected from 21 patients (11 females) and 10 non-patients (6 females). The cross-correlation coefficient between the smartphone and physical activity tracker was 0.70 [0.53–0.83]. The correlation in the non-patients was slightly higher than in the patients (0.74 [0.60–0.90] and 0.69 [0.52–0.81], respectively). Considering the ubiquity, convenience, and practicality of smartphones, the high correlation between the smartphones and the total daily step time-series highlights the potential usefulness of smartphones in detecting the change in the step counts in remote monitoring of the patient's physical activity.

Effects of Differences in Epidural Needle Entry Point and Angle of Rotation of Needle Hub on the Onset and Duration of Sensory Blockade in Lower Limb Orthopaedic Surgeries: A Randomised Controlled Trial

Introduction: Epidural anaesthesia is a boon for providing prolonged analgesia for postoperative pain relief. The influence of epidural needle insertion on the onset of the block, which has not been studied previously, is significant. Aim: To analyse the effect of epidural needle entry and rotation of the needle on the onset and duration of the block. Materials and Methods: This double-blinded randomised controlled trial was conducted at the Department of Anaesthesiology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India from March 2020 to August 2021 on 70 patients undergoing leg and ankle surgeries. They were randomised into Group-ML (midline approach) and Group-PM (paramedian approach). In Group-ML, midline epidural needle entry was followed by catheter insertion. In Group-PM, the needle entry was paramedian, and the bevel was turned 45º towards the surgical site for catheter insertion. A 10 mL of 0.5% bupivacaine was administered. Postoperatively, epidural infusion was initiated using 0.125% bupivacaine with 2 μg/mL fentanyl. The time taken for catheter placement, onset of motor and sensory blockade, maximum sensory level attained, duration of sensory blockade, consumption of local anaesthetics, haemodynamic profile, and the need for rescue analgesia were monitored. Continuous data were analysed using the Student's t-test, and categorical data were analysed using the Chi-squared test with International Business Machines (IBM) statistical product and service solutions software version 27.0 Results: Both groups were comparable with respect to demographics. The mean age in Group-ML was 40.9±25.93 years, while in Group-PM it was 41.028±20.576 years, with a p-value of 0.981. The mean BMI in Group-ML was 24.91±2.998 kg/m2 , while in Group-PM it was 24.96±2.527 kg/m2 , which was statistically insignificant with a p-value of 0.944. A total of 21 males in Group-ML and 28 males in Group-PM participated in the study; the distribution was found to be statistically insignificant with a p-value of 0.067. The time taken for the placement of the epidural catheter was around 288 seconds in Group-ML and 322 seconds in Group-PM, with a p-value of 0.0035. The onset of sensory block was around 17 minutes in Group-ML and 13 minutes in Group-PM, respectively, with a p-value of 0.0001. The duration of sensory block or the time taken for two-segment regression of level was around 102 minutes and 128 minutes in Group-ML and Group-PM, respectively (p-value 0.0001). The rescue analgesic was required in seven patients of Group-ML and none in Group-PM, with a p-value of 0.005. The haemodynamic profile intra and postoperatively and postoperative VAS score were statistically insignificant between the groups. Conclusion: The paramedian approach and epidural catheter insertion with the needle rotated at an angle of 45º towards the surgical side provide a rapid onset of the sensory and motor block with extended duration of the sensory blockade and reduced consumption of local anaesthetics.

Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Block and Three-in-one Block in Elderly Patients Undergoing Hip Surgeries: A Randomised Double-blinded Clinical Trial

Introduction: Hip surgery is a common surgical procedure in the elderly population, leading to significant pain. Ultrasound (USG) guided regional nerve blocks are a newer, safe, and effective postoperative pain control modality for elderly patients. Aim: To compare the analgesic efficacy of Fascia Iliaca Compartment Block (FICB) with the three-in-one block for postoperative analgesia in elderly patients after lower limb orthopaedic surgeries. Materials and Methods: It was a randomised double- blinded study performed at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India on 60 elderly patients of Americian Soceity of Anaesthesiologists (ASA) class I-II scheduled for elective hip and femur shaft surgery under spinal anaesthesia.All patients were randomly allocated into two groups. Group A received ultrasound-guided FICB with 35-40 mL of 0.25% bupivacaine, and group B received ultrasound-guided three-in-one block with 35-40 mL of 0.25% bupivacaine after completion of surgery. In the postoperative period, pain was assessed using the Visual Analogue Scale (VAS), and inj. diclofenac sodium 1.5 mg/kg intravenous (i.v.) was given as rescue analgesic whenever VAS was ≥4. The primary outcome was changes in VAS scores at rest and during passive leg elevation between the two groups at various time intervals within 24 hours. Secondary outcomes measured were the duration of analgesia and total rescue analgesic required in 24 hours. Qualitative variables were compared between groups using the Chi-square test. A p-value<0.05 was considered statistically significant. Results: Demographic data were comparable in both groups, with a mean age of 65.11±1.89 years in Group A and 65.57±1.46 years in Group B. The VAS score at rest was significantly lower in Group A compared to Group B at the 6th hour (1.21±1.17 vs. 1.61±0.78) and 12th hour (2.80±0.12 vs. 3.33±0.92), respectively. The VAS score during passive movement was significantly lower in Group A at the 6th hour and 12th hour compared to Group B. The mean time for the first demand of rescue analgesic was 9.27±2.16 hours in the Fascia Iliaca Compartment Block (FICB) group and 6.67±1.45 hours in the three-in-one group. The difference was significant, with a p-value of 0.006. The mean requirement of total rescue analgesia was 133.33±33.27 mg in Group A and 198.53±29.16 mg in Group B, which was statistically significant. Conclusion: The fascia iliaca block had lower pain scores both at rest and during passive movement compared to the three-inone block. Total analgesic requirement was lower in the fascia iliaca group compared to the three-in-one block group.

A Comparative Study between Intrathecal Dexmedetomidine vs Ketamine with Intrathecal Bupivacaine in Orthopedic Lower Limb Surgeries

A Comparative Study between Intrathecal Dexmedetomidine vs Ketamine with Intrathecal Bupivacaine in Orthopedic Lower Limb Surgeries

Comparative study of the efficacy of fentanyl and buprenorphine transdermal patch for post-operative analgesia in lower-limb orthopedic surgery

Background: Opioids are frequently employed as part of a comprehensive perioperative pain management strategy. Among the various routes of administering analgesics, transdermal drug delivery systems offer advantages over oral and parenteral methods. Transdermal opioid patches represent a contemporary approach to managing post-operative pain due to their non-invasiveness, prolonged efficacy, and reduced reported side effects. Aims and Objectives: This study aimed to assess the effectiveness of post-operative pain reduction using buprenorphine and fentanyl patches in patients undergoing surgeries for lower limbs in the department of orthopedics. Materials and Methods: This comparative and cross-sectional study included 80 adult patients undergone lower-limb surgeries for orthopedic conditions. They are randomly divided into two groups. In Group B (n = 40), buprenorphine patches at 10 μg/h were applied, while in Group F (n = 40), fentanyl patches at 25 μg/h were applied 12 h before surgery. Mean visual analog scale (VAS) scores, sedation scores, total rescue analgesic requirements, and any perceived or reported adverse effects were assessed over a 72-h post-operative period. Results: The age, body weight, and duration of surgeries between the two groups were similar. The VAS scores indicated lower pain levels in the group receiving fentanyl patch compared to the group of patients receiving buprenorphine patch. The total consumption of the analgesic injection was lower in the group receiving the fentanyl patch. Sedation scores and adverse effects were more prevalent in patients receiving buprenorphine patches compared to the group receiving fentanyl patches. Conclusion: For pain management in patients undergoing lower-limb surgeries, the fentanyl transdermal patch demonstrates greater effectiveness compared to the transdermal buprenorphine patch. Hence, doctors may think using it for their patients for better pain management and well-being of the patients.

Efficacy of Magnesium vs Dexamethasone as an Adjuvant to Ropivacaine in Ultrasound Guided Femoral and Sciatic Nerve Block for Postoperative Analgesia: A Prospective, Double Blinded Randomized Controlled Study

Background: In patients undergoing lower limb orthopaedic surgery, unrelieved post-operative pain not only results in discomfort to the patients but also predispose to the development of chronic pain syndromes. The dawn of ultrasonographic-guided techniques has led to increased interest in femoro-sciatic nerve block (FSNB) for lower limb orthopaedic surgeries. Efficacy of various adjuvants have been studied to prolong the block and analgesia. In recent years, there is growing interest in magnesium sulphate (MgSO4) and dexamethasone as adjuvants to local anaesthetics in nerve blocks. Duration of post-operative analgesia was the primary outcome of our study, whereas the rescue analgesics requirement, VAS scores and haemodynamic parameters and time required for toe movement were the secondary outcomes.
 Methods: Sixty-patients scheduled to undergo below knee orthopaedic surgeries under subarachnoid block were divided into 2 groups: Group RM(n=30) patients received 38 mL of 0.375% Ropivacaine with MgSO4 150 mg in 2 mL NS and Group RD(n=30) patients received 38 mL of 0.375% Ropivacaine with Dexamethasone 8 mg(2mL) to make total drug volume of 40 mL. In all patients, 20 mL of LA solution was injected around femoral nerve and 20 mL around sciatic nerve. The primary outcome was duration of post-op analgesia and secondary being requirement of rescue analgesia and time for toe movement. Mean variables were analysed and compared with unpaired t-test. Proportions were compared with Chi-square test and Fischer-exact test.
 Results: Duration of analgesia was prolonged with Dexamethasone (18.8 ± 7.8) as compared to MgSO4 (8.8 ± 4.2). In regards to early ambulation, MgSO4(6.78 ± 2.25) was a cut above Dexamethasone (16.43 ± 4.56).
 Conclusion: Both MgSO4 or Dexamethasone added to Ropivacaine prolonged the duration of analgesia, decreased requirement of rescue analgesia. Dexamethasone delays requirement of rescue analgesics with better pain scores as compared to MgSO4.

Epidural nalbuphine versus dexmedetomidine as adjuvants to bupivacaine in lower limb orthopedic surgeries for postoperative analgesia: a randomized controlled trial

BackgroundAdministration of adjuvant drugs epidurally in combination with local anesthetics offers new dimensions in the management of postoperative pain. This study aimed to compare the addition of either nalbuphine or dexmedetomidine to epidural bupivacaine for postoperative analgesia in lower limb orthopedic surgeries under combined spinal-epidural anesthesia.MethodsThis prospective randomized double-blind study included 69 patients scheduled for lower limb orthopedic surgeries. Anesthesia was started with 15 mg hyperbaric bupivacaine 0.5% intrathecally, and then an epidural bolus dose of 12 ml (10 ml 0.25% bupivacaine with 2 ml normal saline in group C, 2 ml (10 mg) nalbuphine in group N or dexmedetomidine 2 ml (100 µg) in group D was administered when sensory regression to T10. Postoperatively, when visual analogue scale (VAS) was ≥ 3, an epidural top-up dose of 8 ml (6 ml 0.25% bupivacaine plus 2 ml normal saline in group C, 2 ml (2 mg) nalbuphine in group N or 20 µg dexmedetomidine (2 ml) in group D was given. The primary outcome was to evaluate the duration of postoperative analgesia and secondary outcomes were any side effects and patient satisfaction.ResultsThe onset of epidural analgesia was 17.83 ± 2.53 versus 13.39 ± 1.27 versus 12.17 ± 1.27 min in groups C, N and D, respectively (p value < 0.001). The mean duration of analgesia was 241.3 ± 14.24 versus 318.38 ± 22.54 versus 365.87 ± 18.01 min in groups C, N and D, respectively (p value < 0.001). The mean sedation score was less in group C than group N and D (P < 0.001). The patient satisfaction score showed the lowest degree of satisfaction in group C (p value < 0.001). Top-up doses consumed and total analgesic requirements were lower in groups N and D than in group C. There was a statistically significant difference between the studied groups regarding VAS over time (p value < 0.001), intraoperative bradycardia (p value 0.029), and shivering (p value 0.029).ConclusionThe addition of either nalbuphine or dexmedetomidine to epidural bupivacaine was effective for postoperative analgesia in terms of onset, duration, and patient satisfaction with the superiority of dexmedetomidine over nalbuphine.Trial registrationApproval from the research ethics committee of the Faculty of Medicine, Zagazig University was obtained with the reference number (ZU-IRB#:7045-15-8-2021) and it was registered under clinicaltrials.gov (NCT05041270) on registration date 13/09/2021.

Effect of Intrathecal versus Intravenous Dexamethasone on Quality of Spinal Anesthesia in Lower Limb Orthopedic Surgery

Effect of Intrathecal versus Intravenous Dexamethasone on Quality of Spinal Anesthesia in Lower Limb Orthopedic Surgery

An incidental finding of xanthochromia during spinal anaesthesia in a patient posted for lower limb surgery

BackgroundXanthochromia is the yellowish discoloration of cerebrospinal fluid associated with serious conditions like subarachnoid haemorrhage and spinal cord tumour which raises concerns regarding safety when presented during spinal anaesthesia. There is limited literature regarding the clinical implications of spinal anaesthesia in xanthochromia.Case presentationWe report a case of a 31-year-old male patient with an incidental finding of xanthochromia cerebrospinal fluid during spinal anaesthesia. The patient with a history of fall was posted for lower limb orthopaedic surgery under subarachnoid block. In the process of administering the block, the pale yellow coloured cerebrospinal fluid was encountered.ConclusionWe conclude that proceeding with spinal anaesthesia in xanthochromia should be at the discretion of the anaesthesiologist and further investigations for the diagnosis can be considered for the management in such cases.

Evaluation of adding magnesium sulphate to intrathecal bupivacaine in lower limb orthopedic surgery

BackgroundA subarachnoid block is the cheaper and widely used regional block for lower limb surgery. Postoperative pain occurs after lower limb orthopedic surgery from moderate to severe. We conducted a prospective, randomized, double-blind controlled trial. All patients were assessed for onset and duration of sensory and motor block, total duration of analgesia, and postoperative pain relief.This study was conducted to evaluate the efficacy of intrathecal bupivacaine with magnesium undergoing lower limb orthopedic surgery.ResultsOne hundred patients were randomly divided into two equal groups. Group M: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml (50 mg) of preservative-free 25% of magnesium sulphate. Group B: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml preservative-free 0.9% normal saline. The mean time that occurred for the sensory blockade at T10 was 2.49 ± 0.49 min in group B, while it was 4.13 ± 0.74 min in group BM (p value < 0.0001). The mean of the total duration of the sensory block in group B was 139.5 ± 32.01 min, while it was 366.4 ± 30.12 min in group BM (p value < 0.0001). The time taken for the onset of motor block in group B was 5.28 ± 1.31 min, while it was 7.86 ± 1.19 min in group BM (p value < 0.0001). The mean total duration of the motor block in group B was 136.3 ± 8.19 min, while it was 336.5 ± 37.08 min in group BM (p value < 0.0001). The total duration of analgesia in group B was 141.4 ± 14.85 min, while it was 365.9 ± 44.91 min in group BM (p value < 0.0001). The mean dose required for rescue analgesia in group B was 2.2 ± 1.14, while in group BM was 1.28 ± 0.96 (p value < 0.0001).ConclusionsThe addition of 50 mg magnesium sulphate in intrathecal hyperbaric bupivacaine significantly prolongs the extended duration of sensory, motor blockade, and total duration of analgesia for patients undergoing lower limb orthopedic surgery.

Anesthetic efficacy and safety of ropivacaine 0.75% versus bupivacaine 0.5% for spinal anesthesia in patients undergoing lower limb orthopedic surgery

Background: Ropivacaine, a new amino-amide local anesthetic agent, is similar in chemical structure to bupivacaine. The low solubility of ropivacaine leads to greater sensory-motor differentiation by blocking sensory nerve fiber more readily than motor nervefibers. Early recovery of motor function is associated with decreased incidence of venous thromboembolism and early mobilization. Aims and Objectives: The present study aimed to compare the anesthetic efficacy and safety of hyperbaric ropivacaine 0.75% with hyperbaric bupivacaine 0.5% in spinal anesthesia in patients undergoing lower limb orthopedic surgery. Materials and Methods: A total of 60 patients aged between 18 and 60 years of either sex, ASA I and II, undergoing elective lower limb orthopedic surgery were randomly divided into two groups, ropivacaine (R) and bupivacaine (B) group. Group R received 3 mL of 0.75% hyperbaric ropivacaine and group B received 3 mL 0.5% hyperbaric bupivacaine intrathecally. The efficacy in terms of onset and duration of anesthesia, quality of anesthesia, and hemodynamic and safety in terms of complications were noted. Results: Group R produced faster onset of sensory block (ropivacaine 2.6±0.53 min; bupivacaine 3±0.56 min; P&lt;0.006) and the mean duration of sensory block was significantly lesser compared to Group B (Ropivacaine 121.16±7.73 min; Bupivacaine 180.34±11.56 min; P&lt;0.0001). Patients in Group R has significantly more rapid recovery of a motor blockade than Group B (ropivacaine 149.5±8.64 min; bupivacaine 210.17±13.19 min; P&lt;0.0001). Conclusion: Hyperbaric ropivacaine 0.75% was found to be a comparable alternative to hyperbaric bupivacaine 0.5% in patients undergoing lower limb orthopedic surgery.

Role of Preoperative Oral Rehydration Solution on Myocardial Ischaemia During Orthopaedic Surgery under Spinal Anaesthesia: A Prospective Randomised Study.

Preoperative oral rehydration solution (ORS) supplementation offers wide postoperative benefits, but its role in reducing post-spinal myocardial ischaemia is uncertain. We evaluated this aspect in elective lower limb orthopaedic surgeries and compared it to conventional preoperative fasting. Prospectively, we randomised 126 patients aged >60 years into two groups: (A) received reconstituted ORS (1000 mL) during the overnight preoperative fasting, continued up to 2 hrs prior to spinal anaesthesia (SA) induction; (B) kept on conventional overnight preoperative fasting. This study evaluated electrocardiographic ischaemic changes at 2, 5, 10, 15, and 30 minutes after SA induction. In total, 27 patients (group A: 7; group B: 20) developed transient electrocardiographic ischaemic changes. On intergroup comparison, group B had a significantly higher incidence at all time points, with highest statistical levels at 5- and 10-minutes ((P < 0.001). The receiver operating characteristic curve at a threshold fasting duration (fluids) of >3 hours, had an area-under-curve of 0.74 to predict such changes within 30 minutes of SA induction (sensitivity 96.30%, specificity 55.56%, accuracy 64.29%, odds ratio 32.50, relative risk 20.80, (P < 0.001). Post-spinal hemodynamic changes were higher in group B than in A; hypotension and tachycardia were statistically significant ((P=0.020). The pleth variability index was significantly higher ((P < 0.001), while perfusion index was significantly lower (P < 0.001) in group B at all time points. Preoperative ORS supplementation significantly reduced post-spinal transient ischaemic electrocardiographic changes in elderly patients than conventional overnight fasting.

A COMPARISON BETWEEN INTRATHECAL NALBUPHINE AND DEXMEDETOMIDINE AS ADJUVANTS TO HYPERBARIC BUPIVACAINE FOR LOWER LIMB ORTHOPEDIC SURGERIES

Objective: Sub arachnoid block is a reasonably safe and simple technique of regional anesthesia. This randomized double-blind study was conducted to compare the efficacy of intrathecal nalbuphine and Dexmedetomidine as adjuvant with hyperbaric bupivacaine for lower limb orthopedic surgeries. Methods: Sixty adult patients of American Society of Anaesthesiologists physical status 1 and 2 who were scheduled for elective lower limb orthopedic surgeries were divided into two groups, D and N, of 30 each. Group D patients received dexmedetomidine 4 mcg and Group N received nalbuphine 2 mg as adjuvant along with bupivacaine heavy 0.5% (3 mL) intrathecally. Sensory and motor block characteristics and time to first rescue analgesic (intravenous tramadol 100 mg) were the primary end points and drug-related side effects such as pruritis, nausea, vomiting, and respiratory depression were taken as secondary end points. Subsequently, data were entered into Microsoft Excel spreadsheet and Statistical Package for the Social Science software version 22 was used for statistical analysis. Results: All 60 patients showed adequate block. The onset of sensory and motor block was statistically comparable in both groups. The duration of sensory and motor block and duration of analgesia were markedly extended in dexmedetomidine group patients. There were no significant intraoperative or post-operative side-effects in both group of patients. Conclusion: Dexmedetomidine (4 mcg) increases the sensory and motor block duration and duration of post-operative analgesia significantly more than nalbuphine (2 mg), when administered intrathecally as an adjuvant to bupivacaine (15 mg).

To compare the efficacy of intrathecal 0.75% heavy ropivacaine and 0.5% heavy bupivacaine for lower abdominal and lower limb surgery

Background: Spinal anesthesia is the most popular regional anesthesia technique for lower limb and lower abdominal surgery. Bupivacaine 0.5% heavy is commonly used for intrathecal use. New long-acting local anesthetic agents such as ropivacaine have claimed benefits of reduced cardiac toxicity on overdose and more specific effects on sensory rather than motor nerve fibers. The use of intrathecal hyperbaric ropivacaine is not much studied. With this background, we studied intrathecal ropivacaine hyperbaric 0.75% against intrathecal bupivacaine hyperbaric 0.5% for lower abdominal and lower limb surgery. Aims and Objectives: To note the effectiveness of intrathecal ropivacaine and bupivacaine on characteristics of subarachnoid block such as sensory block, motor block, hemodynamic parameters, and complications if any. Materials and Methods: We randomized patients undergoing lower abdominal surgeries and lower limb orthopedic surgeries under spinal anesthesia into two groups so as to receive intrathecal either ropivacaine 0.75% hyperbaric (3 mL) or bupivacaine 0.5% hyperbaric (3mL) and noted study parameters. Results: Time of sensory block onset (P=0.0005), peak sensory level (P=0.0029), and onset of L1 bromage-3 motor block (P=1.27E–08) was significantly delayed in the ropivacaine group as compared to bupivacaine group. However, maximum sensory level achieved (T6), time required for two-segment sensory regressions (P=0.1162), and time of onset of pain (P=0.1162) were comparable in both groups. Conclusion: Intrathecal ropivacaine 0.75% hyperbaric produced slow onset sensory and motor block than 0.5% hyperbaric bupivacaine with comparable cephalic spread and duration of sensory block.

Comparison of efficacy of intrathecal fentanyl as an adjuvant to bupivacaine and ropivacaine in lower limb orthopaedic surgeries for post-operative analgesia

Background: Sub-arachnoid block or spinal anaesthesia is a common mode of anaesthesia that is used for lower limb orthopaedic surgeries. Bupivacaine hydrochloride is a long-acting amide anaesthetic used extensively intrathecally. It has the ability to effectively block sensory and motor pathways. However, it has drawbacks, like cardiotoxicity and neurotoxicity. Ropivacaine is a long-acting amide local anaesthetic agent. It has the capacity to block sensory nerves more than motor nerves. Ropivacaine has reduced potential for neurotoxicity and cardiotoxicity. Fentanyl is a synthetic opioid. It can be added as an adjuvant to local anaesthetic agents used intrathecally. Fentanyl is characterised by its high potency, rapid serum elimination, and minimal histamine release. The blood-brain barrier can be quickly crossed by fentanyl, which takes one to two minutes to generate analgesia. Objectives: To compare post-operative analgesia in patients receiving bupivacaine with fentanyl and ropivacaine with fentanyl in lower limb orthopaedic surgeries via sub-arachnoid block; onset, duration of analgesia, duration of sensory and motor blockade; study the haemodynamic stability of patients in both groups; compare the requirement of 24 hours rescue analgesia; to compare the incidence of side effects. Methodology: This study will be a comparative interventional study which will be conducted on 60 adult patients of both sexes posted for lower limb orthopaedic surgery. They will be randomly divided into two groups with 30 patients in both groups. Group A: Patients receiving bupivacaine 3 mL with fentanyl 25 µg and Group B: Patients receiving ropivacaine 3mL with fentanyl 25 µg. The onset of and duration of block (sensory as well as motor), hemodynamic parameters, post-operative analgesia time and side effects (if any) will be recorded. Trial registration: Submitted to Clinical Trial Registry of India (CTRI) Trial REF/2023/05/067586